This application addresses broad Challenge area (09): Health Disparities and the Specific Challenge Topic, 09-MD-103*: Initiating Innovative Interventions to Prevent Family Violence. The adverse emotional and physical health burden of intimate partner violence (IPV) falls disproportionately on low income women, contributing to intergenerational transmission of violence and to the health disparities seen in urban minority populations. High prevalence rates among patients seen in health care settings provide abundant opportunity for IPV risk identification, early intervention and prevention. However, after two decades of calls for routine screening, there is still no evidence that IPV screening improves outcomes for abused women. In large part this is because practical effective routine screening methods have not been implemented and providers have been reluctant to initiate the discussion given the lack of adequate system-wide responses to IPV identification. Our proposal builds on strong preliminary work that finds allowing patients to self- disclose IPV risk as part of a social health survey significantly increases identification of IPV. However, IPV identification alone will not reduce family violence. Our multi-disciplinary research team includes the Philadelphia Department of Public Health (PDPH), community-based advocacy organization, Institute for Safe Families, Health Federation of Philadelphia with its innovative home visiting advocacy program, and Brown Partners, a local social marketing firm specializing the design of culturally-appropriate health promotion messages. Together, we propose a large scale demonstration project using a quasi-experimental design to evaluate the impact of a multi- level intervention on IPV detection and social work counseling. The four intervention components are (1) an effective social health screening procedure 2) provider training and social marketing to increase IPV awareness and elevate clinician confidence in their ability to address and refer IPV;(3) IPV- focused motivational counseling for male and female patients by specially trained social workers;and (4) community-based family advocates providing social support and help linking abused women to resources. In addition to the demonstration trial, a pilot treatment study will recruit 60 abused women to assess intervention acceptability, feasibility and procedures for collecting data needed for a large randomized controlled trial. The goal of the future RCT will be to test the effectiveness of the multi-level intervention for improving outcomes for abused women. Consistent with the goals of reducing disparities and economic stimulus, this project builds community-based research infrastructure. It will be conducted in four Philadelphia Health Department community health centers serving 50,000 low income primarily minority patients, and will create 6 new FTE jobs.